Financial Assistance Program
When patients inform us that they cannot afford the cost of care, we work hard to minimize the financial impact. However, if patients choose not to discuss their financial status, set up re-payment plans, actively pursue state or federal funding, or apply for the program, we respect their decision.
Fairbanks Memorial Hospital offers an in-house Financial Assistance Program for those patients who qualify. Applications for financial assistance are available at the time of service and throughout the active billing cycle in the Admissions or Business Offices, or you may contact your financial counselor to have an application mailed to your home.
The Basic Financial Assistance Program
If you are an uninsured patient, you will qualify for the Basic Program if you have an annual household income of less than $125,000 and lack any other assets to pay the full hospital charges. If you qualify for the Basic program, you will be charged "Amounts Generally Billed," which is based upon the average of the amounts that would have been paid to the hospital by private health insurers and Medicare (and co-pays and deductibles) for the medically necessary services that you receive, if you had been insured.
The Enhanced Financial Assistance Program
If you are an underinsured patient, you will qualify for the Enhanced Program (1) if you have an annual household income equal to or less than 300 percent of the Federal Poverty Level and lack other assets to pay the hospital's full charges and, (2) if requested to do so by the hospital, you apply for Medicaid, fully cooperate in the application and determination process, and are denied Medicaid coverage
If you qualify for either the Basic or the Enhanced Programs, you will in no case be charged more than Amounts Generally Billed for emergency services or other medically necessary services. In addition, you will never be required to make advance payment or other payment arrangements in order to receive emergency services.
This program is not guaranteed and is largely based on verified annual household income and family size. The income standards used in our program are in accordance with the expanded federal poverty guidelines established by the Centers for Medicare and Medicaid Services (CMS) specifically for the state of Alaska.
Applications will be reviewed for final determination only after all possible payment resources have been considered.
While we strive to make this process as simple as possible, it is critical that annual income be verified to ensure that the correct amount of assistance is applied. Financial Assistance Applications are valid for one year, although each individual medical visit may require re-verification of income.
Please submit your application and the following supporting documents to the Business Office:
- Copy of previous year's official federal income tax return for each adult living in the home
- Additional income verification may be requested for each adult living in the home. This may include three months of income information such as pay stubs or banking statements (checking and/or saving accounts)
- If you were not required to file federal tax returns, bank statements and proof of income from other sources (for example, Social Security, worker's compensation, public assistance, retirement, unemployment benefits, child support) will be required
FMH is committed to protecting your privacy. Your federal tax return and financial information will not be released to any third party agency without your consent in accordance with HIPAA compliance standards.
Helping as Many as We Can
Our financial assistance is not without limitations. We may periodically adjust our assistance scales relative to our healthcare facility's financial position. Your signature on the Financial Assistance Application certifies that you have provided information that it is true and complete to the best of your knowledge.
We understand that unique circumstances arise in each family's financial situation. That's why it is so important for patients to discuss their financial concerns with an FMH financial counselor. If you have any questions, feel that you have extenuating circumstances or believe that you may qualify for assistance, please make an appointment with a financial counselor.
To speak with your financial counselor regarding assistance or to make an appointment, please call according to your last name.
- A through K (907) 458-5532
- L through Z (907) 458-5539
If you have questions regarding a pending assistance application, please call our Financial Processor at (907) 458-5510.